Hypospadias Repair with Tubularized Preputial Transvers Island Flap

Abstract

Various surgical techniques have been defined for hypospadias repair due to position of meatus and chordee delormity. Single stage hypospadias repair with preputial transverse island flap described by Duckett is one of them. The ages, meatal position and the degrees of chordee of 47 patients in whom transverse island flap hypospadias repairs were performed were reviewed. Operation time, urinary diversion, stenting time, complications and hospital stay for each patient were determined. Three months after the operations the outcomes including urethral calibration and penile cosmetic appearances were evaluated. Ages of the cases ranged between 4 and 16 (mean 6.4) years. There were mid and proximal penile hypospadias in 19 (40%) and 28 (60%) of the cases, respectively. Moderate ventral chordee was present in all of the cases. Glanduloplasty with glandular tunnel or glandular wing flaps were performed in 23 and 24 of the cases, respectively. Suprapubic cystostomy in 57% and a urethral catheter in 43% of the patients were used as being urinary diversion. Mean operation time, stenting time and hospital stay were found 85 minutes, 7.6 and 9.6 days, respectively. Postoperative complications included urethral fistula in 23.4%, proximal or distal anastomotic urethral strictures in 8.5% and penile rotation in 2.1% of the cases. The incidence of urethral fistula in patients with proximal hypospadias or urethral catheter or glandular tunnel was more than patients with mid penile hypospadias or suprapubic cystostomy or glanduloplasty with glandular wind flaps (p < 0.05). An adequate uniform urethral calibration and a sufficient straight penis were obtained in 66% of the patients. In conclusion, preputial transverse island flap repair is an ideal single stage procedure in uncircumcised patients with ventral chordee and mid or proximal penile hypospadias although with this relatively higher complication rate.